Tropical Diseases in Hawaii

WAILUKU, Maui (HONOLULU ADVERTISER) -- State health officials are planning to hold community meetings in East Maui after a pig hunter in Hana contracted leptospirosis, the first case of the bacterial infection on the Valley Isle in eight years.

The man became ill in late December and was hospitalized for several days but recovered, said Dr. Lorrin Pang, Maui district health officer with the state Department of Health. The source of the illness was just confirmed last week.

Leptospirosis is a bacterial disease that affects humans and animals. Humans become infected through contact with water, food or soil containing urine from infected animals such as cattle, wild pigs and rats.

The last reports of leptospirosis contracted on Maui occurred in 1999, when there were three cases, one each at 'Iao Valley in Wailuku and the 'Ohe'o Pools in Kipahulu, and a third at an unknown stream.

Disease investigators are at a loss to explain why the disease should surface now after years of no reports. When the Health Department has conducted routine testing of rodents and mongooses, Maui has been found to have a much smaller rate of leptospirosis infection than other islands, said Erick Cremer, vector-borne surveillance coordinator for the department's Disease Investigation Branch.

Pang said, "We could have missed it, so either (the new case) is a fluke or a freaky thing, or it's on the rise."

Roughly half of the leptospirosis cases in the United States occur in Hawai'i, where residents and visitors are drawn to idyllic waterfalls and mountain pools that may be contaminated. Also at risk are campers, hunters, taro and prawn farmers, construction workers and others who spend a lot of time outdoors.

There have been nine fatalities from leptospirosis contracted in Hawai'i since 1990. The last known death occurred in 2004, when a college student from the Big Island fell ill on the Mainland following a trip home during which he hiked and swam in freshwater pools.

I'm sure the cited case wasn't the only leptospirosis infection on Maui in the past 8 years. There were undoubtedly several more that were never recognized.

I caught leptospirosis when I was a pig hunter in Hana, Maui, but the quacks at the local medical clinic misdiagnosed it as dysentery. Years later my doctor in Honolulu misdiagnosed my case of dengue fever as the flu, claiming that dengue fever had been unknown in Hawaii for the past half century. He was unaware of the fact that a dengue epidemic had been raging out of control for some time in the South Pacific and that thousands of travelers come from that region to Hawaii every year.

It amazes me how medical and health officials in Hawaii are so ill-prepared to recognize common tropical diseases. Most come from the Mainland where tropical diseases are mere footnotes in their training and they don't bother to learn any more about them once they are settled here.

Hello? Hawaii is in the tropics and therefore prone to the same diseases found in other tropical areas around the world. Because of this ignorance, people here die unnecessarily when doctors fail to make the correct diagnosis and provide treatment with drugs that work.

The article didn't mention the presence of other tropical diseases in Hawaii. One is liver fluke, a pathogen found in giant African snails that were common in Hana. Kids were allowed to play with the snail shells because nobody warned them they risked infection by a potentially fatal disease.

Hawaii also has a very high rate of giardiasis infections from local drinking water -- an estimated 11% of the population. Although this disease is seldom life-threatening, it has unpleasant symptoms and could be prevented by a special water treatment process. But once again Hawaii health officials are either unaware of this problem or choose to ignore it due to the cost of upgrading water treatment plants.

If you come to Hawaii on vacation, realize you are entering the Third World healthwise. Don't drink the tap water or swim in freshwater pools or pick up snail shells in the rainforest. If you contract a tropical disease, you won't get much help from the medical profession here.

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"The earth was made round so we can't see too far down the road and know what is coming." -- Isak Dinesen, Out of Africa